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Priority handling action code

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Updated on August 31, 2021

The priority handling action code is used to see if a specific member, policy, contract or billing provider is listed in the priority handling configuration tables. If they are reported, then the priority handling action code (A-416) is reported on the claim.

The primary use case for this action code is to route claims for specific members, providers, contracts or policies to a specialized work queue or to change the minimum urgency on the claim if they suspend. This will enable these claims to be handled differently to other claims that have been submitted to the SCE. This action code is provided as part of the claim business edits module. The decision tables controlling this are:

AM_Priority_Member – Validates the member’s ID on the claim for priority handling.

AM_Priority_Policy – Validates the member’s policy ID for priority handling

AM_Priority_Contract – Validates the membership contract for priority handling.

AM_Priority_BillingProvider – Validates the billing provider’s tax ID for priority handling.

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